Provider Demographics
NPI:1861898496
Name:COPPIN, DANIELLE MARIE (DC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:COPPIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SW STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2550
Mailing Address - Country:US
Mailing Address - Phone:515-965-8280
Mailing Address - Fax:
Practice Address - Street 1:1310 SW STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2550
Practice Address - Country:US
Practice Address - Phone:515-965-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1457466328Medicaid
1457466328Medicare PIN